Faculty Opinions recommendation of Pulmonary vein region ablation in experimental vagal atrial fibrillation: role of pulmonary veins versus autonomic ganglia.

2008 ◽  
Author(s):  
Andreas Goette
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Vein ◽  
Pulmonary Veins ◽  
Autonomic Ganglia

scholarly journals Prospective Randomized Clinical Trial of Wide Area Circumferential Pulmonary Vein Ablation versus Segmental Pulmonary Vein Ablation for Pulmonary Vein Isolation as a Treatment for Short-Duration Paroxysmal Atrial Fibrillation

2021 ◽  
Author(s):  
Sapan Bhuta ◽  
Gustaf Sverin ◽  
Hiro Kawata ◽  
Malek Bashti ◽  
Jessica Hunter ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Vein ◽  
Short Duration ◽  
Pulmonary Vein Isolation ◽  
Paroxysmal Atrial Fibrillation ◽  
Pulmonary Veins ◽  
Wide Area ◽  
Pulmonary Vein Ablation ◽  
Total Procedure Time

Background: Previous studies suggest that wide area circumferential pulmonary vein ablation (WACA) is more effective than segmental pulmonary vein ablation (SPVA) for pulmonary vein isolation (PVI) for treatment of atrial fibrillation. Whether this is true in patients (pts) with very short duration paroxysmal atrial fibrillation (PAF) is unknown. Objective: To compare WACA to SPVA in pts with PAF lasting <48 hours. Methods: One hundred pts with PAF <48 hours were randomized to either WACA vs SPVA (45 and 53 pts respectively, with 2 withdrawals), and followed up for 24 months with 14-day ECGs every 6 months. Results: Among 97 pts at an average of 22.1±4.8 months followup, 26 (57.8%) remained free of any atrial arrhythmias after WACA versus 29 (55.86%) after SPVA (p=0.64). Sixteen pts (35.6%) had recurrent PAF after WACA versus 20 pts (38.5%) after SPVA (p=0.79). Seven pts (15.6%) had atrial flutter after WACA versus 5 pts (9.64%) after SPVA (p=0.376) and 1 pt (2.2%) had atrial tachycardia after WACA vs 1 pt (1.9%) after SPVA (p=0.918). Total procedure time was lower for SPVA vs WACA (242.9 vs 271.1 minutes, p= 0.047), and fluoroscopy time similar for WACA vs SPVA (50.8 vs 53.4 minutes, p=0.555). Conclusions: As an initial ablation approach in pts with PAF <48 hours, SPVA was similarly effective to WACA with respect to arrhythmia recurrence, supporting the central role of the pulmonary veins for maintaining AF in these pts. Future therapies using alternative ablation energies may incorporate these insights to reduce risk to gastroesophageal structures.

scholarly journals The role of pulmonary veins vs. autonomic ganglia in different experimental substrates of canine atrial fibrillation

2010 ◽  
Vol 89 (4) ◽  
pp. 825-833 ◽  
Author(s):  
Kunihiro Nishida ◽  
Ange Maguy ◽  
Masao Sakabe ◽  
Philippe Comtois ◽  
Hiroshi Inoue ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Veins ◽  
Autonomic Ganglia

scholarly journals Coronary Sinus Ablation Is a Key Player Substrate in Recurrence of Persistent Atrial Fibrillation

Cardiology ◽  
2019 ◽  
Vol 143 (3-4) ◽  
pp. 107-113 ◽  
Author(s):  
Naseer Ahmed ◽  
Shahida Perveen ◽  
Adeela Mehmood ◽  
Gulab Fatima Rani ◽  
Giulio Molon
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Vein ◽  
Coronary Sinus ◽  
Pulmonary Veins ◽  
Persistent Atrial Fibrillation ◽  
Arrhythmogenic Substrate ◽  
Electrophysiological Procedures ◽  
Very High ◽  
Insight Into

Atrial fibrillation (AF) is the most frequent atrial arrhythmia. During the last few decades, owing to numerous advancements in the field of electrophysiology, we reached satisfactory outcomes for paroxysmal AF with the help of ablation procedures. But the most challenging type is still persistent AF. The recurrence rate of AF in patients with persistent AF is very high, which shows the inadequacy of pulmonary vein isolation (PVI). Over the last few decades, we have been trying to gain insight into AF mechanisms, and have come to the conclusion that there must be some triggers and substrates other than pulmonary veins. According to many studies, PVI alone is not enough to deal with persistent AF. The purpose of our review is to summarize updates and to clarify the role of coronary sinus (CS) in AF induction and propagation. This review will provide updated knowledge on developmental, histological, and macroscopic anatomical aspects of CS with its role as arrhythmogenic substrate. This review will also inform readers about application of CS in other electrophysiological procedures.

scholarly journals Persistent Atrial Fibrillation: The Role of Left Atrial Posterior Wall Isolation and Ablation Strategies

2021 ◽  
Vol 10 (14) ◽  
pp. 3129
Author(s):  
Riyaz A. Kaba ◽  
Aziz Momin ◽  
John Camm
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrial ◽  
Pulmonary Veins ◽  
Treatment Strategies ◽  
Persistent Atrial Fibrillation ◽  
Posterior Wall ◽  
Cardiovascular Death ◽  
Good Effect ◽  
Complex Forms

Atrial fibrillation (AF) is a global disease with rapidly rising incidence and prevalence. It is associated with a higher risk of stroke, dementia, cognitive decline, sudden and cardiovascular death, heart failure and impairment in quality of life. The disease is a major burden on the healthcare system. Paroxysmal AF is typically managed with medications or endocardial catheter ablation to good effect. However, a large proportion of patients with AF have persistent or long-standing persistent AF, which are more complex forms of the condition and thus more difficult to treat. This is in part due to the progressive electro-anatomical changes that occur with AF persistence and the spread of arrhythmogenic triggers and substrates outside of the pulmonary veins. The posterior wall of the left atrium is a common site for these changes and has become a target of ablation strategies to treat these more resistant forms of AF. In this review, we discuss the role of the posterior left atrial wall in persistent and long-standing persistent AF, the limitations of current endocardial-focused treatment strategies, and future perspectives on hybrid epicardial–endocardial approaches to posterior wall isolation or ablation.

scholarly journals Asymptomatic Pulmonary Vein Stenosis: Hemodynamic Adaptation and Successful Ablation

2016 ◽  
Vol 2016 ◽  
pp. 1-4
Author(s):  
John J. Lee ◽  
Denis Weinberg ◽  
Rishi Anand
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Artery ◽  
Pulmonary Vein ◽  
Pulmonary Veins ◽  
Lung Perfusion ◽  
Atrial Fibrillation Ablation ◽  
Clinical Severity ◽  
Pulmonary Vein Stenosis ◽  
Multiple Imaging ◽  
Vein Stenosis

Pulmonary vein stenosis is a well-established possible complication following an atrial fibrillation ablation of pulmonary veins. Symptoms of pulmonary vein stenosis range from asymptomatic to severe exertional dyspnea. The number of asymptomatic patients with pulmonary vein stenosis is greater than originally estimated; moreover, only about 22% of severe pulmonary vein stenosis requires intervention. We present a patient with severe postatrial fibrillation (AF) ablation pulmonary vein (PV) stenosis, which was seen on multiple imaging modalities including cardiac computed tomography (CT) angiogram, lung perfusion scan, and pulmonary angiogram. This patient did not have any pulmonary symptoms. Hemodynamic changes within a stenosed pulmonary vein might not reflect the clinical severity of the obstruction if redistribution of pulmonary artery flow occurs. Our patient had an abnormal lung perfusion and ventilation (V/Q) scan, suggesting pulmonary artery blood flow redistribution. The patient ultimately underwent safe repeat atrial fibrillation ablation with successful elimination of arrhythmia.

Abstract 16807: Role of Rotor Activation Within the Pulmonary Vein as the Driving Sources for Atrial Fibrillation: Three-dimensional Analysis using a Non-contact Mapping System

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Hiroshige Yamabe ◽  
Hisanori Kanazawa ◽  
Tadashi Hoshiyama ◽  
Miwa Ito ◽  
Shozo Kaneko ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Vein ◽  
Three Dimensional ◽  
Recording Site ◽  
Contact Mapping ◽  
Proximal Half ◽  
Mapping System ◽  
Endocardial Mapping ◽  
Activation Sequence

Background: It has been suggested rotor which is located within the pulmonary vein (PV) acted as the driving sources of atrial fibrillation (AF). However, it has never been confirmed whether or not the rotor exists within PV in human. Objectives: We analyzed the activation sequence within the PV during AF and examined how the PV acted as the driving sources of AF. Methods: Selective endocardial mapping of left superior PV (LSPV) was performed during AF in 11 paroxysmal AF patients using a non-contact mapping system (EnSite 3000). Presence of rotor activation was defined when the circular activation around the functional block line once completed its whole reentrant activation. We analyzed the relation between the pivoting activation and the rotor activation. To define the preferable site of rotor and pivoting activation, we also analyzed the relation between the location of rotor and pivoting activation and region of the complex fractionated electrogram (CFE) recording site. Results: Rotor activation was observed with a mean number of 4.6±3.6 times/sec. CFE was observed at the roof (n=5), ridge (n=11) and carina (n=7) of the proximal half of LSPV with a mean area of 9.1±3.4 cm2. The number of rotor activation observed at the CFE area was significantly higher than that at the non-CFE area (4.1±3.9 vs. 0.7±1.2 times/sec, p=0.025). Total frequency of pivoting activation was 37.0±14.7 times/sec. Pivoting activation involved in the rotor activation was significantly lower than that not involved in the rotor activation (8.8±8.1 vs. 27.7±15.8 times/sec, p=0.0116). Regarding the CFE area, pivoting activation involved in the rotor activation was also significantly lower than that not involved in the rotor activation (8.4±8.2 vs. 24.1±12.0 times/sec, p=0.0105). However, there was no difference between the frequencies of pivoting activation with and without rotor activation in the non-CFE area (1.0±2.0 vs. 3.6±6.1 times/sec, p=NS). Conclusions: Rotor activation was observed at the proximal portion of the LSPV coincided with the location of CFE area. However, most of pivoting activation was not involved in the rotor activation. These suggest that AF was driven by the other meandering propagation associated with frequent non-stable pivoting activation over the CFE area.

Abstract 2753: The Relationship Between Pulmonary Vein Antrum Scarring Following Atrial Fibrillation Ablation and Procedural Success: Does Pulmonary Vein Isolation Matter?

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Troy J Badger ◽  
Robert S Oakes ◽  
Akram Shabaan ◽  
Nazem W Akoum ◽  
Nathan M Segerson ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Vein ◽  
Pulmonary Veins ◽  
Posterior Wall ◽  
Kaplan Meier ◽  
Number Of Patients ◽  
Procedural Success ◽  
The Relationship ◽  
Af Recurrence

Background. A mechanism of atrial fibrillation (AF) recurrence following ablation may be incomplete pulmonary vein antrum (PVA) scarring that allows for conduction between the pulmonary veins (PV) and the left atrium (LA). We report the relationship between circumferential PV scarring detected by delayed enhancement MRI (DE-MRI) and AF recurrence following PVAI. Methods. Eighty-six patients presenting for PVAI underwent DE-MRI 3 months post ablation. Circumferential ablation with posterior wall debulking was performed in all patients. PV ostia were marked on 3D images generated from the MRI data and assessed by consensus of two independent reviewers for the extent of scarring. Complete PVA scarring was defined as a continuous ring of enhancement surrounding the PVA. For patients with incomplete scarring, the degree of scarring was estimated. Results. The figure shows two patients from the cohort, Patient 1 exhibits successful scarring of all PVA. Patient 2 shows scarring of 1 PVA. At three months post ablation, complete circumferential lesion was seen on 131/335 PVA (39.1%). Complete scarring of 4 PVA was seen in 9 patients (10.5%), scarring of 3 PVA in 11 patients (12.8%) and scarring of 2 PVA was seen in 17 patients (19.8). Twenty-nine patients (33.7%) exhibited complete scarring in 1 PVA while 20 patients (23.3%) exhibited scarring in 0 PVA. Kaplan Meier analysis (Figure [E] ), suggests that PVA isolation may be important for long-term procedural success. Conclusion: Complete pulmonary vein antrum scarring exists in a very limited number of patients, despite its apparent importance for long-term procedural success.

P1415Wide antral circumferential pulmonary vein isolation ablation using a novel balloon cryoablation catheter

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
A P Martin ◽  
M Fowler ◽  
N Lever
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrium ◽  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Paroxysmal Atrial Fibrillation ◽  
Left Atrial ◽  
Pulmonary Veins ◽  
Posterior Wall ◽  
The Novel ◽  
Median Treatment

Abstract Background Pulmonary vein isolation using cryotherapy is an established treatment for the management of patients with paroxysmal atrial fibrillation. Ablation using the commercially available balloon cryocatheter has been shown to create wide antral pulmonary vein isolation. A novel balloon cryocatheter (BCC) has been designed to maintain uniform pressure and size during ablation, potentially improving contact with the antral anatomy. The extent of ablation created using the novel BCC has not previously been established. Purpose To determine the anatomical extent of pulmonary vein isolation using electroanatomical mapping when performing catheter ablation for paroxysmal atrial fibrillation using the novel BCC. Methods Nine consecutive patients underwent pre-procedure computed tomography angiography of the left atrium to quantify the chamber dimensions. An electroanatomical map was created using the cryoablation system mapping catheter and a high definition mapping system. A bipolar voltage map was obtained following ablation to determine the extent of pulmonary vein isolation ablation. A volumetric technique was used to quantify the extent of vein and posterior wall electrical isolation in addition to traditional techniques for proving entrance and exit block. Results All patients had paroxysmal atrial fibrillation, mean age 56 years, 7 (78%) male. Electrical isolation was achieved for 100% of the pulmonary veins; mean total procedure time was 109 min (+/- 26 SD), and fluoroscopy time 14.9 min (+/- 2.4 SD). The median treatment applications per vein was one (range one - four), and median treatment duration 180 sec (range 180 -240). Left atrial volume 32 mL/m2 (+/- 7 SD), and mean left atrial posterior wall area 22 cm2 (+/- 4 SD). Data was available for quantitative assessment of the extent of ablation for eight patients. No lesions (0 of 32) were ostial in nature. The antral surface area of ablation was not statistically different between the left and right sided pulmonary veins (p 0.63), which were 5.9 (1.6 SD) and 5.4 (2.1 SD) cm2 respectively. In total 50% of the posterior left atrial wall was ablated.  Conclusion Pulmonary vein isolation using a novel BCC provides a wide and antral lesion set. There is significant debulking of the posterior wall of the left atrium. Abstract Figure.

scholarly journals The Role of Adenosine in Pulmonary Vein Isolation: A Critical Review

2016 ◽  
Vol 2016 ◽  
pp. 1-13 ◽  
Author(s):  
Paolo D. Dallaglio ◽  
Timothy R. Betts ◽  
Matthew Ginks ◽  
Yaver Bashir ◽  
Ignasi Anguera ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
At Risk ◽  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Waiting Time ◽  
Critical Review ◽  
Recurrence Rates ◽  
The Impact ◽  
Af Recurrence

The cornerstone of atrial fibrillation (AF) ablation is pulmonary vein isolation (PVI), which can be achieved in more than 95% of patients at the end of the procedure. However, AF recurrence rates remain high and are related to recovery of PV conduction. Adenosine testing is used to unmask dormant pulmonary vein conduction (DC). The aim of this study is to review the available literature addressing the role of adenosine testing and determine the impact of ablation at sites of PV reconnection on freedom from AF. Adenosine infusion, by restoring the excitability threshold, unmasks reversible injury that could lead to recovery of PV conduction. The studies included in this review suggest that adenosine is useful to unmask nontransmural lesions at risk of reconnection and that further ablation at sites of DC is associated with improvement in freedom from AF. Nevertheless it has been demonstrated that adenosine is not able to predict all veins at risk of later reconnection, which means that veins without DC are not necessarily at low risk. The role of the waiting period in the setting of adenosine testing has also been analyzed, suggesting that in the acute phase adenosine use should be accompanied by enough waiting time.

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